THE OCCUPATIONAL THERAPY FIELD

The History of Occupational TherapyYou’re entering an admirable health profession with roots that goback at least 200 years in history. A brief understanding of the estab-lishment of the occupational therapy profession will give you a senseof its purpose and its approach to treatment.

Occupational therapy today is used to treat both physical and psychi-atric conditions in patients. However, the first philosophical founda-tions of occupational therapy can be found in the area of treatingmentally ill patients.

In 1786, French physician Philippe Pinel used manual activity as ameans of returning psychiatric patients to their previous interests,work, and final recovery. During that same time, an American physi-cian, Benjamin Rush, was the primary supporter for the use of labor,exercise, and interests in the recovery of patients with mental ill-nesses.

In 1892, Adolf Meyer, an American psychiatrist, promoted the use ofgratifying activity which helped mentally ill patients return to normalfunction in society. He stressed the importance of a balance of work,play, and rest. Meyer’s later published works began to outline a for-mal philosophy for what would eventually become the occupationaltherapy profession.

In 1914, a New York architect named George Edward Barton openedan institution which used work as a means of therapy in treating awide range of physical and mental illnesses and disabilities. Con-vinced of the benefits of using meaningful activity in rehabilitation,Barton named his approach to treatment occupational therapy.

Occupational therapy was formally established as a profession inMarch 1917 at the first meeting of the National Society for the Promo-tion of Occupational Therapy. The name was changed to AmericanOccupational Therapy Association (AOTA) in 1923 (Figure 1).

As injured soldiers returned from World War I, the need for occupa-tional therapy in treating physical disabilities increased. Reconstruc-tion aides were the forerunners of modern occupational therapists.These aides were civilian employees who worked with patientssuffering from both physical and mental disabilities. World War II

Introduction to Occupational Therapy

1

further expanded the use of occupational therapy in physical injuryrehabilitation.

The AOTA has grown from only 40 members at its creation to wellover 50,000 members in 1998. The purpose of the AOTA is to supporta professional community for members and to promote occupationaltherapy as a profession. The Association also issues guidelines andstandards that ensure a high quality of patient rehabilitation care. TheAOTA publishes three periodicals for its membership, which provideinformation on developments within the profession, employment op-portunities, and continuing-education programs. Check the Resourcessection in this study unit for more information on AOTA periodicalsand other publications that will help you in your new career.

Definition and Key Terms of Occupational TherapyYou’ll notice some new terms and concepts in this section. Be sure toread the definitions but don’t be too concerned if you don’t under-stand the full meanings at first. We’ll be reviewing the most impor-tant concepts throughout this program. As you continue to study,you’ll soon become comfortable with the ideas and vocabulary re-lated to your new career.

What exactly is occupational therapy? Occupational therapy is thetherapeutic use of self-care, work, and play activities to increaseindependent function, enhance development, and prevent disability.Occupational therapy may include the accommodation of a task orenvironment to achieve maximum independence and quality of life.Let’s take a look at each part of this definition to make sure you un-derstand what it means.

Occupation

So what does the occupation in occupational therapy actually mean?Occupations are activities or tasks that use a person’s resources of time

2 Introduction to Occupational Therapy

FIGURE 1—Founders of theAmerican OccupationalTherapy Association (AOTA)in 1917. Standing, left to right,Dr. William Rush Dunton, Jr.,Miss Isabel G. Newton, andThomas B. Kidner. Seated,left to right, Miss Susan C.Johnson, George EdwardBarton, and Mrs. EleanorClarke Slagle. (Photo courtesy Ar-chives of the American OccupationalTherapy Association, Inc., Bethesda, MD.Reprinted with permission.)

and energy. As the definition of occupational therapy indicates, thetasks used in treatment are activities that a person uses to take care ofoneself, to do work, and to enjoy leisure time. Examples of a patient’soccupations could include getting dressed, entering data into a com-puter, and crocheting.

The Therapeutic Use of Self-Care, Work, and PlayActivities

One of the distinctive traits of occupational therapy is that it treats thepatient as a whole individual. Therefore, occupational therapy em-ploys the entire range of a person’s activities and interests to promoterehabilitation. Treatment begins by addressing the most basic self-careactivities. Self-care tasks are sometimes referred to as activities of dailyliving (ADL). These tasks can include grooming, bathing, toileting,dressing, eating, socializing, communicating, mobility, and sexual ex-pression (Figure 2).

Occupational therapy also uses activities that patients perform in or-der to meet their need to be productive individuals. These work activi-ties, or productive activities, fall into four general categories: (1) homemanagement, (2) care of others, (3) educational activities, and (4) vo-cational activities. Work activities may include—but aren’t limitedto—meal preparation and cleanup, shopping, money management,work or job performance, retirement planning, going to school, andcaring for a family member.

Occupational therapy is concerned with patients’ ability to receivesatisfaction and enjoyment from their environments. Play activities, orleisure activities, are activities that individuals do for recreation or re-laxation. These activities can include hobbies, sports activities, andcreative activities.

Introduction to Occupational Therapy 3

FIGURE 2—Self-care taskscan include grooming, eat-ing, toileting, and mobility.

Increasing Independent Function, EnhancingDevelopment, and Preventing Disability

Independent function describes a patient’s ability to perform a task withas little reliance on others as possible. For the patient with a physicaldisability, increasing independent function might involve performingstrengthening exercises, installing grab bars in a hallway, and trainingthe patient to prepare meals using modified techniques. With occupa-tional therapy treatment, the patient would be able to go about dailylife with greater independence than before treatment.

Occupational therapy is used to enhance development in cases wherepatients have disorders that cause deficiencies or delays in properfunctioning. Development-enhancing treatment is often given to pre-mature infants and children who have cerebral palsy or musculardystrophy. In these cases, therapy would focus on promoting devel-opment of movement and/or communication functions.

Without treatment, certain conditions may cause temporary or per-manent disability. For instance, individuals with tendon injuries canpotentially lose some or all of the function in the injured part of thebody. Occupational therapy prevents disabilities by providing treat-ment to avoid the loss of function.

Adapting Tasks and Environments

Occupational therapy may also include adapting a task or an environ-ment to gain the highest degree of independence and the greatestquality of life for the patient. For example, an occupational therapyprofessional might suggest the use of a dressing stick for someonewho is unable to dress independently due to limitations in movement(Figure 3). An occupational therapist might also recommend the useof a transfer board for someone who has difficulty moving from achair to a bed.

4 Introduction to Occupational Therapy

FIGURE 3—Occupationaltherapy often includesadapting, or changing, atask to help the patientachieve maximum inde-pendent function.

Purposeful Activity

Purposeful activity has always been a central focus of occupationaltherapy. Purposeful activities are the behaviors or tasks that make upoccupations. These behaviors or tasks are directed towards a specificgoal. To be considered a purposeful activity, the individual must beparticipating actively and voluntarily toward a goal that the individ-ual considers meaningful. For a mentally ill patient who previouslyenjoyed woodworking as a hobby, for example, occupational therapytreatment may include the purposeful activity of constructing a desk-top bookshelf.

Occupational therapy practitioners use purposeful activity to evalu-ate, simplify, restore, or maintain a patient’s ability to function in hisor her daily occupations. Using purposeful activity in therapy pro-duces many benefits, including the following:

� Purposeful activity focuses attention on a meaningful goalrather than on the process required for achievement (Figure 4).

� Purposeful activity assists and builds on the individual’s abili-ties and leads to the achievement of personal functional goals.

� Purposeful activity encourages coordination of the individual’svarious body systems.

� Purposeful activity provides feedback on performance to boththe occupational therapy practitioner and the individual.

Now let’s take a moment to review. Occupational therapy focuses onpatients’ day-to-day involvement in occupations (activities) that or-ganize their lives and meet their needs. These needs would includetaking care of themselves (self-care), being productive (work), and

Introduction to Occupational Therapy 5

FIGURE 4—Usingpurposeful activity intherapy focuses atten-tion on a meaningfulgoal rather than on theprocess required forachievement.

receiving enjoyment and satisfaction in their environments (leisure).Occupational therapy includes performing activities of daily living(ADL) as routine as bathing and dressing. Occupational therapy alsoaddresses more involved and complex tasks that are related to one’swork and leisure environments. Patients engage in purposeful activi-ties, or therapeutic activities, that are meaningful to them and pro-mote independence. If necessary, tasks and environments arechanged to meet the ability level of the patient.

Occupational therapy treatment considers all physical, psychological,and social factors related to individuals’ ability to function in theirparticular home, work, or leisure environment (Figure 5). The therapistdiscovers what personal goals the patients have, and what motivatesthe patients toward the achievement of these goals. The therapist

6 Introduction to Occupational Therapy

FIGURE 5—Occupational therapy considers all factors related to an individual’s ability to function on a day-to-daybasis.

needs to know something about the patient’s family structure andnetwork of friends to design and implement effective treatment. Apatient’s cultural traditions that influence food preparation, clothingrestrictions, and/or holiday observances are factored into therapywhen necessary. These factors are examined in order to make treat-ment as effective and as meaningful to the individual as possible.

Settings for Occupational TherapyThere’s a good demand for occupational therapy professionals. This isgood news for you as you start your career as an occupational ther-apy aide. You’ll most likely have the opportunity to choose fromamong several work settings where occupational therapy is practiced.

You might choose to work in a rehabilitation hospital, children’s hos-pital, school, nursing home, the psychiatric unit of a hospital, an out-patient clinic, or another occupational therapy setting (Figure 6).

When selecting where you would like to work, you’ll want to con-sider which age group you’re most gifted to work with—children,teens, middle-aged people, the elderly, or a blend of age groups.You’ll also want to explore whether you want to help individualswho are recovering from severe to minor physical, developmental, oremotional disabilities. Let’s examine some of the settings where occu-pational therapy aides can work.

HospitalsHospitals have traditionally been one of the biggest employers of oc-cupational therapy professionals. Hospitals also provide occupationaltherapy aides with the opportunity to work with the widest variety ofage groups and types of disabilities.

Introduction to Occupational Therapy 7

FIGURE 6—Occupationaltherapy aides are employedin a variety of settings, in-cluding general and spe-cialty hospitals.

Many acute care hospitals use occupational therapy professionals totreat both physical and psychiatric disabilities. An acute care hospitalis a health care facility that provides care for most conditions—fromsetting broken bones to cancer therapy to psychiatric services. Someacute care hospitals also offer outpatient occupational therapy services.

A hospital that specializes in treating a specific condition or agepopulation is called a specialty hospital. Examples of specialty hospitalsinclude psychiatric hospitals for the care of mentally ill patients andpediatric hospitals for the care of children. Occupational therapy de-partments in these hospitals serve patients with a more narrowly de-fined age or disability.

State and Federal InstitutionsThe government provides money to state and federal institutions sothat these institutions can provide care for the physical and psychiat-ric needs of specialized patients. Some examples of state and federalinstitutions that might offer occupational therapy services includeprisons, psychiatric hospitals, facilities for the mentally retarded, Vet-eran’s Administration (VA) hospitals, armed services hospitals, andpublic-health agencies.

Rehabilitation HospitalsPhysicians are increasingly referring patients with certain conditionsto rehabilitation hospitals. These facilities provide short-term care for in-dividuals who need around-the-clock nursing care and intensive ther-apy following a stroke, certain surgeries, disease, or serious injury.Because patients are sent to rehabilitation hospitals to receiveintensive therapy, the occupational therapy and physical therapy de-partments are essential units of the health care team at these facilities(Figure 7).

8 Introduction to Occupational Therapy

FIGURE 7—The occupationaland physical therapy de-partments are essential ser-vice units in rehabilitationhospitals.

Outpatient Clinics and CentersWhen a patient is able to return home after a hospital stay, the physi-cian may recommend additional therapy at an outpatient clinic or cen-ter. These facilities offer occupational and physical therapy to patientswho are able to live at home and come to the facility to receive dailyor weekly treatment. Offering therapy on an outpatient basis is lessexpensive for health care providers because the patient doesn’t re-quire around-the-clock nursing or supervision. Outpatient therapyalso allows patients to return to the comfort of familiar surroundings,which can also mean a quicker return to normal routines and inde-pendence.

Some outpatient clinics offer services in very remote rural settings.However, these clinics offer the same quality and range of services asa hospital. The advantages to the patient of attending an outpatientclinic include convenience and less crowded surroundings.

Many employees are injured on the job each year or are disabled byoff-the-job accidents or other medical conditions. Work-hardening fo-cuses on helping patients regain the functions they need to return totheir jobs as soon as possible without reinjuring themselves. Both oc-cupational and physical therapy professionals work in outpatientwork-hardening centers. These professionals work with disabled em-ployees on an outpatient basis to perform the specific occupations theworkers need to get back to work. Work-hardening centers set upsimulated work environments to help workers regain strength andconfidence before actually returning to their jobs (Figure 8).

Both outpatient rehabilitation clinics and work-hardening centers em-ploy numerous therapists. Therefore, occupational therapy aides canexpect these clinics and centers to be especially interested in theirskills.

Introduction to Occupational Therapy 9

FIGURE 8—Outpatientwork-hardening centersuse simulated workenvironments to helpworkers regain functions,build stamina, and gainconfidence before return-ing to their jobs.

Long-Term Care Facilities

Patients who require 24-hour, long-term nursing care often live inlong-term care facilities such as nursing homes and residential centers.Residents of long-term care facilities are typically elderly and/or seri-ously impaired. Patients are placed in these facilities for long-term re-habilitation with the goal to return to living an independent lifestyle.Some patients may require permanent residency if independent liv-ing isn’t a possibility. Long-term care facilities generally provide ther-apy services to those patients with rehabilitation potential. Thenumber of jobs available to occupational therapy professionals inthese facilities has greatly increased.

Schools

Public, private, and specialty schools—such as those for the mentallyretarded—employ occupational therapy workers. These occupationaltherapy workers are hired to help students receive the maximumbenefit from the educational programs that are offered (Figure 9). Oc-cupational therapy workers might work in only one school at a timeor in several schools on a rotating basis.

Elementary school children usually benefit most from occupationaltherapy because of the rapid developmental changes that take placeduring this young age. Occupational therapy professionals work withstudents who have a range of disabilities, including the following:

� Developmental and learning disabilities

� Speech, language, and hearing impairment

10 Introduction to Occupational Therapy

FIGURE 9—Most publicschool districts and manyprivate schools employ oc-cupational therapy workers.These occupational therapyworkers provide studentswith therapeutic interventionto become as independentas possible in the school set-ting so that they’ll be able toachieve the best learningability possible. (Photo by Photo-graphic Details)

� Physical, emotional, and mental impairment

The following are some examples of occupational therapy interven-tion in the school setting.

� Helping a child to hold a pencil in a deformed hand, using anadaptive device

� Positioning a child with poor sitting posture in order to main-tain balance to permit reading or typing

� Providing individualized neurodevelopmental therapy to chil-dren with central nervous system disorders, such as cerebralpalsy

Community Centers

Over the past decade, community centers have started to offer an exten-sive range of services to local residents. Some examples of communitycenters that employ occupational therapy workers include

� Mental health care centers

� Day care centers for disabled children or adults (Figure 10)

� Community centers sponsored by United Cerebral Palsy, the Ar-thritis Foundation, Muscular Dystrophy Association, and otherlocal social and health agencies

Individuals who attend community centers usually go to the centerevery day or drop in on an occasional basis as activities are sched-uled. According to a recent AOTA publication, these community set-tings that are in need of occupational therapy professionals areexpected to be the areas with the most job opportunities.

Introduction to Occupational Therapy 11

FIGURE 10—A day care cen-ter for disabled children is atype of community centerthat employs occupationaltherapy workers.

Work-Setting Preferences—A Self-Inventory

Occupational therapy aides can work in a range of settings. Some ofthese settings include hospitals, state and federal institutions, out-patient centers and clinics, long-term care facilities, schools, and com-munity centers. The job opportunities that are available vary consid-erably depending on where you live.

Before you can decide which work setting might be a good careermatch, you’ll need more time to learn more about the occupationaltherapy profession, your own abilities, and the facilities that are avail-able in your town or city. Take a moment to complete the followingself-inventory to see where you think you might like to work.

12 Introduction to Occupational Therapy

1. I enjoy working with the following age group:

Age Group Possible Work Settings

Pediatrics Acute care hospital, children’s hospital, day carecenter, community center, school, group homefor the mentally retarded

Adults Acute care hospital, rehabilitation hospital, VAhospital, psychiatric hospital, facility for thementally retarded, outpatient rehabilitationclinic, outpatient work-hardening center,community center

Elderly Acute care hospital, rehabilitation hospital, VAhospital, facility for the mentally retarded,outpatient rehabilitation clinic, communitycenter, long-term care facility

2. I enjoy working with the following disabilities:

Disability Possible Work Settings

Physical disabilities Acute care hospital, children’s hospital, VAhospital, rehabilitation hospital, outpatientrehabilitation clinic, outpatient work-hardeningcenter, day care center, long-term care facility,school, community center

Developmental Day care center, school, community center,disabilities facility for the mentally retarded

Emotional Acute care hospital, psychiatric hospital, VAdisabilities hospital, school, community center, day care

center, facility for the mentally retarded,long-term care facilities

Introduction to Occupational Therapy 13

Self-Check 1At the end of each section of Introduction to Occupational Therapy, you’ll be asked topause and check your understanding of what you’ve just read by completing a “Self-Check.” Writing the answers to these questions will help you review what you’ve studiedso far. Please complete Self-Check 1 now.

Questions 1–5 and 7–9: Select the one best answer to each question.

1. What’s the name of the organization that was established to promote the profession ofoccupational therapy?

a. American Federation of Occupational Therapy (AFOT)

b. Society for the Promotion of Occupational Therapy (SPOT)

c. American Occupational Therapy Association (AOTA)

d. Organization of Occupational Therapy Professionals (OOTP)

2. Which one of the following is an example of increasing a patient’s independentfunction?

a. Removing grab bars and assistive devices in the patient’s home

b. Dressing the patient every morning and walking him or her to the bathroom

c. Feeding the patient three meals a day and helping him or her with mobility

d. Instructing the patient on how to prepare meals using modified techniques

3. Philippe Pinel’s approach to therapy primarily used _______ as a means to returnpatients to normal function.

a. manual activity c. medication

b. hypnosis d. automated activity

4. Psychiatrist Adolf Meyer published works outlining a philosophy of therapy based onthe use of _______ activity.

a. work c. random

b. gratifying d. relaxing

5. Who first used the term occupational therapy to describe using work as therapy to treatboth physical and mental illnesses?

a. Benjamin Rush c. William Morris

b. George Edward Barton d. William Rush Dunton, Jr.

6. True or False? The purposeful activities used in therapy don’t have to be meaningful tothe patient as long as the therapist believes they’re important.

(Continued)

THE OCCUPATIONAL THERAPY TEAM

As an occupational therapy aide, you’ll be working in cooperationwith other members of the occupational therapy team who will de-pend on your assistance. Each member of the team plays a special rolein helping the patient to recover. You’ll play a very important part inassisting patients and making sure that they receive quality care.

The occupational therapy team includes

� Occupational therapists (Some with more experience and educa-tion may have managerial positions such as director, assistantdirector, or supervisor.)

� Occupational therapy assistants

� Occupational therapy aides

� Occupational therapy students

� Volunteers

Depending on where you’ll work, your interaction, specific tasks, andcommunication with other occupational therapy professionals willvary.

14 Introduction to Occupational Therapy

Self-Check 17. Grooming, bathing, and socializing activities are examples of _______ tasks.

a. self-care c. leisure

b. work d. purposeful

8. _______ are designed specifically to help employees return to their jobs as quickly andsafely as possible by providing treatments that simulate tasks done on the job.

a. Outpatient work-hardening centers c. Community centers

b. Long-term care facilities d. Outpatient mental health clinics

9. Which one of the following statements is true of occupational therapy?

a. Every patient follows the same treatment plan.

b. Purposeful activity encourages the patient’s coordination.

c. Occupational therapy works independently of other medical professionals.

d. Interpersonal relationships play a minor role in the occupational therapy process.

Check your answers with those on page 37.